Provider Demographics
NPI:1639214125
Name:PUGET SOUND DRUG CORPORATION
Entity type:Organization
Organization Name:PUGET SOUND DRUG CORPORATION
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PHARMACIST OWNER
Authorized Official - Prefix:
Authorized Official - First Name:HEE-JOO
Authorized Official - Middle Name:
Authorized Official - Last Name:PARK
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:206-878-3900
Mailing Address - Street 1:530 S 336TH ST
Mailing Address - Street 2:SUITE A
Mailing Address - City:FEDERAL WAY
Mailing Address - State:WA
Mailing Address - Zip Code:98003-6383
Mailing Address - Country:US
Mailing Address - Phone:206-878-3900
Mailing Address - Fax:206-878-1114
Practice Address - Street 1:530 S 336TH ST
Practice Address - Street 2:SUITE A
Practice Address - City:FEDERAL WAY
Practice Address - State:WA
Practice Address - Zip Code:98003-6383
Practice Address - Country:US
Practice Address - Phone:206-878-3900
Practice Address - Fax:206-878-1114
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-21
Last Update Date:2012-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPHAR.CF.602662783336C0004X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0004XSuppliersPharmacyCompounding Pharmacy